Interhospital variability in localization techniques for small pulmonary nodules in children: A pediatric surgical oncology research collaborative study |
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| Institution: | 1. University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States;2. UPMC Children''s Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 7th FL, Pittsburgh, PA, United States;3. Cincinnati Children''s Hospital Medical Center, Cincinnati, OH, United States;4. The Hospital for Sick Children, Toronto, Ontario, Canada;5. Ann and Robert H Lurie Children''s Hospital of Chicago, Chicago, IL, United States;6. Medical College of Wisconsin/Children''s Wisconsin, Milwaukee, WI, United States;7. Cohen Children''s Medical Center, Queens, NY, United States;8. Mayo Clinic, Rochester, MN, United States;9. University of Utah, Salt Lake City, UT, United States;10. St. Jude Children''s Research Hospital, United States;11. St. Jude Children''s Research Hospital, Memphis, TN, United States;12. C.S. Mott Children''s Hospital, Ann Arbor, MI, United States;13. Seattle Children''s Hospital, Seattle, WA, United States;14. Children''s Hospital Colorado, Aurora, CO, United States;15. American Family Children''s Hospital, Madison, WI, United States;p. Duke University Medical Center, Durham, NC, United States;q. Nationwide Children''s Hospital, Columbus, OH, United States |
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| Abstract: | BackgroundPulmonary nodules that are deep within lung parenchyma and/or small in size can be challenging to localize for biopsy. This study describes current trends in performance of image-guided localization techniques for pulmonary nodules in pediatric patients.MethodsA retrospective review was performed on patients < 21 years of age undergoing localization of pulmonary nodules at 15 institutions. Localization and resection success, time in interventional radiology (IR), operating room (OR) and total anesthesia time, complications, and technical problems were compared between techniques.Results225 patients were included with an average of 1.3 lesions (range 1–5). Median nodule size and depth were 4 mm (range 0–30) and 5.4 mm (0–61), respectively. The most common localization techniques were: wire + methylene blue dye (MBD) (28%), MBD only (25%), wire only (14%), technetium-99 only (11%), coil + MBD (7%) and coil only (5%). Localization technique was associated with institution (p < 0.01); technique and institution were significantly associated with mean IR, OR, and anesthesia time (all p < 0.05). Comparing techniques, there was no difference in successful IR localization (range 92–100%, p = 0.75), successful resection (94–100%, p = 0.98), IR technical problems (p = 0.22), or operative complications (p = 0.16).ConclusionsMany IR localization techniques for small pulmonary nodules in children can be successful, but there is wide variability in application by institution and in procedure time.Level of evidenceRetrospective review, Level 3. |
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